Organization
AIRWAY ANESTHESIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARYL D CHENOWETH CRNA (DIRECTOR)
(309) 454-4617
Entity
Organization
Contact information
Practice address
1105 STERLING GLEN CC CT, NORMAL, IL 61761-5297
(309) 454-4617
(877) 757-6325
Mailing address
1105 STERLING GLEN CC CT, NORMAL, IL 61761-5297
(309) 454-4617
(877) 757-6325
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
209-001108
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
617834300
DEPT OF LABOR
IL
Enumeration date
05/09/2012
Last updated
04/30/2015
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